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Cost-effectiveness and threshold analysis of deep brain stimulation vs. treatment-as-usual for treatment-resistant depression.
Kabotyanski, Katherine E; Najera, Ricardo A; Banks, Garrett P; Sharma, Himanshu; Provenza, Nicole R; Hayden, Benjamin Y; Mathew, Sanjay J; Sheth, Sameer A.
Affiliation
  • Kabotyanski KE; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
  • Najera RA; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Banks GP; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
  • Sharma H; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
  • Provenza NR; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
  • Hayden BY; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
  • Mathew SJ; Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
  • Sheth SA; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA. sameer.sheth@bcm.edu.
Transl Psychiatry ; 14(1): 243, 2024 Jun 07.
Article in En | MEDLINE | ID: mdl-38849334
ABSTRACT
Treatment-resistant depression (TRD) affects approximately 2.8 million people in the U.S. with estimated annual healthcare costs of $43.8 billion. Deep brain stimulation (DBS) is currently an investigational intervention for TRD. We used a decision-analytic model to compare cost-effectiveness of DBS to treatment-as-usual (TAU) for TRD. Because this therapy is not FDA approved or in common use, our goal was to establish an effectiveness threshold that trials would need to demonstrate for this therapy to be cost-effective. Remission and complication rates were determined from review of relevant studies. We used published utility scores to reflect quality of life after treatment. Medicare reimbursement rates and health economics data were used to approximate costs. We performed Monte Carlo (MC) simulations and probabilistic sensitivity analyses to estimate incremental cost-effectiveness ratios (ICER; USD/quality-adjusted life year [QALY]) at a 5-year time horizon. Cost-effectiveness was defined using willingness-to-pay (WTP) thresholds of $100,000/QALY and $50,000/QALY for moderate and definitive cost-effectiveness, respectively. We included 274 patients across 16 studies from 2009-2021 who underwent DBS for TRD and had ≥12 months follow-up in our model inputs. From a healthcare sector perspective, DBS using non-rechargeable devices (DBS-pc) would require 55% and 85% remission, while DBS using rechargeable devices (DBS-rc) would require 11% and 19% remission for moderate and definitive cost-effectiveness, respectively. From a societal perspective, DBS-pc would require 35% and 46% remission, while DBS-rc would require 8% and 10% remission for moderate and definitive cost-effectiveness, respectively. DBS-pc will unlikely be cost-effective at any time horizon without transformative improvements in battery longevity. If remission rates ≥8-19% are achieved, DBS-rc will likely be more cost-effective than TAU for TRD, with further increasing cost-effectiveness beyond 5 years.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Cost-Benefit Analysis / Quality-Adjusted Life Years / Deep Brain Stimulation / Depressive Disorder, Treatment-Resistant Limits: Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Transl Psychiatry Year: 2024 Type: Article Affiliation country: United States

Full text: 1 Database: MEDLINE Main subject: Cost-Benefit Analysis / Quality-Adjusted Life Years / Deep Brain Stimulation / Depressive Disorder, Treatment-Resistant Limits: Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Transl Psychiatry Year: 2024 Type: Article Affiliation country: United States